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In some cases of anorexia nervosa, tube feeding is the only "psychosomatic" means to break through the vicious cycle of illness, but even this must be approached psychotherapeutically. The loss of weight and the accompanying somatic symptoms do not correlate with the seriousness of the psychopathological syndrome. According to Anna Freud, the self-starvation is one expression of "asceticism at puberty" with illusory wish fulfillment. Oral incorporation becomes a prototype of object finding. Sexual fears are displaced onto the body as a whole with delusional ego distortions. Ambivalent relationships to the mother are marked by severe libidinal and ego regressions. In applying these psychodynamics to treatment, Thomä uses psychoanalytically oriented psychotherapy. The greatest problem lies in establishing a working alliance. The most important consideration is to avoid collusion with the patient's denial of reality, and at times the patient must be treated in a hospital. Defenses must be challenged, not glossed over. Because these patients reject physicians' recommendations, marked countertransference attitudes are aroused. Thus, if the patient is on physically safe